1. Field of the Invention
The embodiments are generally directed to implementation of health-related compliance programs instituted by payers or related entities.
2. Summary of Existing Art
Payers, e.g., insurance companies and/or employers, recognize the benefit to all health plan participants with the improved health and well-being of individual plan consumers, e.g., employees or self-insured individuals (“members”). Accordingly, in recent years, payers have worked to implement incentive programs which are meant to incentivize individuals to take care of their health. These incentive programs reward individuals for achieving health-related goals. Such rewards include reductions in co-pays, coinsurance and deductibles to gift cards, contribution to health savings accounts and health reimbursement accounts and the like.
Payers typically have to either build custom processes to evaluate claims or other third party data to identify members who are in compliance with incentive program requirements or pay third parties for this service. And these custom built approaches are not integrated with the reward issuance process and the member tracking of actions within incentive programs nor are they integrated with the eligibility or benefits systems.
Accordingly, there is a need for a system and method that integrates incentive program compliance, reward issuance and tracking.